iSmaRT: imaging small renal tumours
Research type
Research Study
Full title
Dual source CT assessment of ablation success in small renal tumours
IRAS ID
236002
Contact name
Vicky Goh
Contact email
Sponsor organisation
King's College London
ISRCTN Number
ISRCTN15730405
Duration of Study in the UK
2 years, 11 months, 31 days
Research summary
Nephron-sparing treatments have become the standard of care for T1 renal masses. Ablative therapies are a safe alternative to partial nephrectomy with 5-year recurrence-free & cancer-specific survival rates of 95.2 & 99.4% respectively & better preserve renal function. In patients undergoing ablative therapy it may be a challenge to confirm complete ablation (analogous to complete surgical resection). Current practice is the assessment of CT attenuation change pre- & post-therapy. Attenuation of >10 Hounsfield Units (HU) in an area of nodular or crescent-shaped irregularity is considered suspicious for persistent disease. However it is well-known that HU is variable as it is dependent on multiple factors including scanner, underlying tissue contrast, contrast agent dose, administration rate & cardiac output. Indeed peri-procedural studies have shown that small foci of disease are often missed. Thus there is a need to improve peri-procedural assessment & detection of residual disease/early recurrence, allowing earlier intervention in this small but relevant subgroup of patients.
Our systematic review of perfusion imaging following ablation of renal tumours (search date: 23/05/2017) only identified 4 studies (using dynamic contrast enhanced MRI, arterial spin-labelling MRI, perfusion-CT (CTp) & dual energy-CT respectively (DECT); 3 prospective; 90 patients total); a limitation was the lack of gold-standard, low number of recurrences & study heterogeneity; no studies compared DECT with CTp, highlighting the need for further prospective studies in this clinical setting.
Our study aims to investigate whether dual source computed tomography (DSCT & CTp) quantification of vascularisation pre & day 1 post-ablation improves the assessment of residual disease versus complete ablation & predict for early recurrence in renal cancer? Secondarily, we investigate whether DECT iodine mapping can be used interchangeably with CTp parametric mapping in this context. Finally, for a subgroup of 10 patients, we will perform an additional CTp on Day 14 to investigate the ideal timing for perfusion imaging.
REC name
London - City & East Research Ethics Committee
REC reference
18/LO/2005
Date of REC Opinion
22 Jan 2019
REC opinion
Further Information Favourable Opinion